Page 33 - USAP Connected_WINTER 2017

“Going through each step of the checklist and giving each question its due is important for high-quality patient care. Each case is a person. And each person deserves our best. The checklist helps us achieve this optimal care with each case throughout the day, day in and day out.”
Dr. Calder
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These studies also show that the checklist can support a culture of continuous quality improvement.
AT-RISK BEHAVIORS IN THE OR INCLUDE:
• Lackadaisical approach to the checklist
• Full team not present and participating during timeouts
• Not checking the equipment
• Surgeon not present during patient preparation and draping
• Surgeon running two operating rooms simultaneously
• Multitasking
• Relying on memory about the pathology
• Unlabeled clear solutions on the back table
• Unsanitary conditions and not cleansing hands properly
• Using electrosurgical devices in an oxygen-rich environment
• Unannounced substitutions in the middle of a case
• Not accounting for all equipment and sponges prior to closing
up the patient
Studies show that OR teams tend to have the highest compliance during patient ID, type of procedure and antibiotics, and the worst compliance with site of incision. Team member introductions also go by the wayside, taking place only half the time (most likely because teams already know each other).
It’s important to note that the e ectiveness of a checklist depends as much on the attention paid to each step within the checklist as it does the quality and thoroughness of the checklist itself.
A strong culture of continuous quality improvement with a focus on 100 percent patient safety is vital. In the essence of pure patient safety, addressing each and every component of the checklist, as if it was the rst time one has worked through it, is vital to the process.
TIMEOUTS: WHO LEADS?
There are three timeouts prior to surgery:
1. The Block Timeout
2. The Anesthesia Timeout 3. The Surgical Timeout
Who leads is a matter of facility best practices and routine. “Anyone can initiate a timeout,” says Cindy Calder, MD, USAP- Texas in Houston. “Generally, the anesthesia provider initiates the Block Timeout; either the circulating nurse or the anesthesia provider initiates the Anesthesia Timeout—operating together as a team; and then the surgeon initiates the Surgical Timeout. The most important aspect of each timeout is that each member of the surgical team stop everything, be present and participate.”
CHECKLIST IMPLEMENTATION TEAM INCLUDES:
ADMINISTRATOR / QUALITY IMPROVEMENT OFFICER
ANESTHESIOLOGIST AND / OR CRNA CIRCULATING NURSE
SCRUB TECHNICIAN
SURGEON
OTHERS, AS APPROPRIATE (PERFUSIONISTS, BIOMEDICAL ENGINEERS, ANESTHESIA TECHS, PAS, PRE-OP NURSING, ETC.)
ISSUE ONE | CONNECTED
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